Dilation and curettage (D&C) is a procedure in which the cervix of the uterus is expanded (dilated) so that the uterine lining (endometrium) can be removed with a spoon-shaped instrument called a curette. D&C is sometimes necessary to remove tissue after a miscarriage within the first trimester.
What happens before surgery?
Before a D&C, the same general recommendations for other outpatient procedures apply. It is recommended that the patient take nothing by mouth (food, water, etc.) for at least 6 to 8 hours prior to the scheduled operation. Often, the doctor will see the patient the day before surgery to discuss the procedure and potential complications in detail.
Are you awake during a D&C?
Most D&Cs are done under general anesthesia. The procedure is typically very short, and general anesthetic can be quickly reversed, with the patient going home later the same day. Some patients prefer or require spinal or epidural blocks, but these forms of anesthesia take more time for the anesthesiologist to perform and require more recovery time for the patient. Occasionally, in a very motivated patient, the procedure can be done under a local anesthetic with or without intravenous pain medication.
Overall, the choice of anesthetic is generally determined by the surgeon, the
anesthesiologist, and the patient.
What are the possible complications of a D&C?
The D&C procedure has a low risk of serious complications. It is normal to experience vaginal bleeding and/or pelvic cramping (similar to menstrual cramping) for a few days following a D&C. Typically, over-the-counter pain medications will help pain control. The most common complication that can occur is the perforation of the uterus with either
the dilators or the curette. When this happens, as long as no internal organs (intestines, bladder, or rectum) or large blood vessels are damaged, the hole will usually heal itself without further surgery. The risk for this problem is increased in patients with a narrowed opening to the cervix (cervical stenosis) or in females with distorted internal uterine anatomy. This risk is also increased if the uterus is infected or has undergone previous surgeries such as cesarean sections or myomectomies.
Injury to the cervix is another possible complication. Tears or cuts in the cervix can usually be treated by the application of pressure and application of local medications to stop bleeding. In some cases, stitches in the cervix may be required, but this is not common.
Other complications, as with any surgery, include bleeding and infection. Most bleeding is mild and resolves on its own. Infection is also rare and can normally be managed with oral antibiotics. Most D&Cs do not require the routine use of post-operative antibiotics. On occasion, in patients with certain heart defects, the surgeon may give the patient antibiotics before and after the surgery to prevent bacteria from the vagina from infecting the heart valves.
What happens after a D&C?
After the surgery, most patients can return to normal activities within a few days. Nonsteroidal anti-inflammatory medications may be recommended to relieve the mild pain and cramping that may follow. To decrease the chance of developing an infection, doctors advise that patients not use tampons or insert anything into the vagina for two weeks following the surgery, and do not have sexual intercourse for the same time period.
You will have a follow-up appointment usually around 2 weeks after the surgery.
What is a Dilation and Evacuation (D and E, D&E)?
A D&E is done during the second trimester and is pretty similar to a D&C in that it uses a vacuum aspiration, but requires more surgical instruments to remove the tissue (like forceps). Because it’s done later on in a pregnancy, it can take a little longer. A lot of the complications and instructions will be the same as a D&C.
If you have one of these procedures done, you can expect additional lab tests at your follow-up appointments.